Information Collection

Registrations and Recertifications for Entities other than Hospitals

IC 190347 under ICR 201908-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2.1 Registrations and Recertifications for Entities other than Hospitals	Form and Instruction
2.1 340B Registration CHC and FQHCLA.pdf 340B Registration CHC and FQHCLA..pdf	Form and Instruction
2.2 340B Registration STD and TB.pdf 340B Registration STD and TB..pdf	Form and Instruction
2.3 340B Registration-Covered Entities All Other Non-Hospita 340B Registration-Covered Entities All Other Non-Hospitals..pdf	Form and Instruction
2.4 340B Recertfication STD and TB.pdf 340B Recertfication STD and TB..pdf	Form
2.5 340B Recertification CHC and FQHCLA.pdf 340B Recertification CHC and FQHCLA..pdf	Form
2.6 340B Recertification Covered Entities All Other Non-Hosp 340B Recertification Covered Entities All Other Non-Hospital..pdf	Form
Registration CHC and FQHCLA.docx REDLINE Registration CHC and FQHCLA	IC Document
Registration STD.TB.docx REDLINE Registration STD and TB	IC Document
Registration All Other Entities.docx REDLINE Registration Other Entities	IC Document
Recert CHC and FQHCLA.docx REDLINE Recert CHC and FQHCLA	IC Document
Recert STD and TB.docx REDLINE Recert STD and TB	IC Document
Recert All Other Non-Hospital.docx REDLINE Recert Other Non Hospital	IC Document

IC Title:

Registrations and Recertifications for Entities other than Hospitals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2.1	340B Registration CHC and FQHCLA.pdf	340B Registration CHC and FQHCLA..pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2.2	340B Registration STD and TB.pdf	340B Registration STD and TB..pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2.3	340B Registration-Covered Entities All Other Non-Hospitals.pdf	340B Registration-Covered Entities All Other Non-Hospitals..pdf	Yes	Yes	Fillable Fileable
Form	2.4	340B Recertfication STD and TB.pdf	340B Recertfication STD and TB..pdf	Yes	Yes	Fillable Fileable
Form	2.5	340B Recertification CHC and FQHCLA.pdf	340B Recertification CHC and FQHCLA..pdf	Yes	Yes	Fillable Fileable
Form	2.6	340B Recertification Covered Entities All Other Non-Hospital..pdf	340B Recertification Covered Entities All Other Non-Hospital..pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,069

Number of Respondents for Small Entity: 1,200

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	19,451	13,875	5,576
Annual IC Time Burden (Hours)	6,368	3,580	2,788
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REDLINE Registration CHC and FQHCLA	Registration CHC and FQHCLA.docx	08/12/2019
REDLINE Registration STD and TB	Registration STD.TB.docx	08/12/2019
REDLINE Registration Other Entities	Registration All Other Entities.docx	08/12/2019
REDLINE Recert CHC and FQHCLA	Recert CHC and FQHCLA.docx	08/12/2019
REDLINE Recert STD and TB	Recert STD and TB.docx	08/12/2019
REDLINE Recert Other Non Hospital	Recert All Other Non-Hospital.docx	08/12/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.